Ear Diseases
Auricle
(pinna):-
Congenital: accessory auricle, microtia, anotia.
Traumatic: Haematoma.
Infectious: Perichondritis
Neoplastic:
Benign
Malignant: BCC, SCC
Ex. Auditory
Meatus:-
Congenital: atresia.
Impacted wax, F.B.
Tumours:
Benign:
Osteoma
Malignant:
Squamous carcinoma.
BCC.
Adeno carcinoma.
Inflammatory:
Otitis externa:
Localised:
furunculosis caused by staphylococcus aureus.
Diffuse:
Bacterial
Fungal:
Aspergellus
Candida
Viral
Symptoms:
Pain
Discharge
Treatment:
Pain killer.
Suction clearanceà to the ear.
Antibiotic
wick with steroid ointment.
In severe
cases oral and I.V antibiotics.
Necrotising otitis externa (malignant)
Organism: pseudomonas.
Characterised by spread to the bone causing ostitis cranial
nerve palsy, intracarnial spread of infection.
Occurs in autoimmune compromised patients.
Treatment:
I.V antibiotics:
ciprofloxacullus, painkillers.
Wicks.
Debridement
Middle
ear disease:
Infections:
AOA
COM
Acute otitis media:-
Incidence: 16-24 month is the highest.
Actiology: wide horizontally placed Eustachian
tube.
1. More prone to URTI
2. Enlarged adenoid tissue affects the drainage of the ear.
Bacteriology:
Streptococci
Staphylococcus,
H. influenza.
Clinically:-
Infant:
Pyrexia and screaming.
Older children:
Pain
Deafness.
On examination the drum is dull grey, absent light reflex congested
drum and dilated blood vessels.
Investigation:-
PTA: conduction
loss.
Treatment:-
Analgesia
Antibiotics: Amoxil orally or I.V.
Chronic
otitis media:
Chronic suppurative otitis media (CSOM)
Otitis media with effusion (OME)
CSOM
Complication of AOM with persistent perforation in the drum.
Types:
Turbo-tympanic due to persistent infection through the Eustachian
tube causing middle ear problems.
Attico antral disease Due to the development of a retraction
pocket in the pars flaccida which keeps enlarging and with keratin inside (Cholesteatoma) The enzyme secreted by this cholesteatoma
erodes the bone and causes complications.
Clinically: tubotympanic
Discharge
Mucopurulent
Persistent.
Deafness: conductive.
O/E: central anterior or posterior perforation.
Nasal examination, post nasal space examination is also examinated.
Investigation
Swabs for
culture and sensitivity.
Radiology CT scan is helpful in showing bony erosion and the
extent of the disease.
Treatment:-
1. Treat URTI, nose, PNS problems if any.
2. Suction clearance to the ear under the microscope.
3. Antibiotics ear drops with steroids.
4. Surgery: tubotympanic: closed perforation and ossicular repair. (tympanoplasty).
Attico antral disease: mastoid exploration to get rid of the
disease.
Otitis
media with effusion (OME) (Glue ears)
Incidence: mainly children under the age of 10.
Aetiology: Unknown.
Possible causes:
Eustachian
tube problems.
Viral theory
with URTI.
Adenoid enlargement.
Cleft palate.
Pathology:
Cytology:
Exudate
PMNL, macrophage.
Cell debris and biochemically it is viscid fluid contains glycoprotein,
nucleoprotein.
Clinically:-
Symptoms:
Hearing loss
Earache
Signs:
T.M straw
coloured and dull.
Air bubbles,
fluid level.
Indrawn of
T.A
Investigation:
PTA: Conductive
HL
Tympanometry:
flat
Treatment:
In established
cases if it didn't resolve spontaneously.
Myringotomies
± grommets and adenoidents.
2nd
grommet: 35%
3rd grommet: 11%
Complications
of otitis media
Rare nowadays due to Antibiotics.
Spread:
Superiorly:
middle cranial fossa.
Posteriorly
posterior cranial fossa.
Medially:
labyrinth.
Inferiorly:
spread to the jugular bulb.
Extra cranial complications
Mastoiditis
Acute
Sub acute
Chronic
Petrositis.
Labyrinthitis.
Facial nerve paralysis.
Ossicular erosion.
Intra cranial complications:
Extra dural
abscess.
Sub dural abscess.
Lateral sinus thrombosis
Meningitis
Brain abscess:
Temporal.
Cerebellar.
Mastoiditis:
Extension of the infection to the mastoid
antrum into the mastoid air cells.
Clinically:
Symptoms:
Pain behind
the ear
Deafness
Signs:
Tenderness
over mastoid antrum.
Displacement
of pinna downward and outward.
Narrow of the external meatus.
Congested eardrum.
Investigation:
Haematology:
Increased
white cell count.
Radiology:
Plain X-Rays blurring of the cellular mastoid.
CT scan may be indicated for possible complications.
Treatment:
I.V antibiotics
Pain killer
Surgery -
mastoidectomy
Otoscelerosis:
Definition: localised disease of optic capsule.
Aetiology:
Hereditary
tendencies in certain families.
Age: 18-30.
Pathology:
Normal bone replaced by vascular spongy osteoid tissue later
it becomes less vascular.
Site: Anterior margin of oval window (commonest).
Clinically:
Conductive
deafness or mixed deafness
Tinnitus.
O/E:
normal ear drums 90%
active disease (pink-bluish) drum 10%
Treatment:-
Stapedectomy (insert prosthesis).
Inner ear
disease:
Sensory neural deafness:
Congenital:
Acquired:
Infections
Viral: mumps, measles, herpes zoster oticus.
Bacterial:
after otitis media, syphilis
Presbyacusis
Age related
deafness
Ototoxic:
Aminoglycosides
Cytaxoic:
Salicylate
in high dose
Sudden deafness:
90% aetiology
unknown.
Treatment:
Hearing aid.
Cochlear implant.
Vertigo:
Definition: hallucination of movement.
Causes:
Peripheral.
Central.
Peripheral:
Benign paroxysmal positional vertigo:
Attack of the vertigo is related to head movement, due to deposit
of on the Cupula of Posterior semicircular canal.
Treatment: positional test Epply manouveure.
Vestibular Neuronitis
Proceed by
viral URTI with fibrile illness
Treatment: symptomatic.
Meniers disease:
Character:
Deafness: fluctuant SNHL
Vertigo
Tinnitus
Nausea and vomiting
Pathology:
Dilatation of the endolymphatic components (hydropes).
When it rupture potassium is released and causes vertigo.
Aetiology:
Unknown.
Allergy, viral, biochemical theory.
Clinically:
Sudden vertigo.
Fullness of the ear .
O/E:
Nystagmus (peripheral in type)
Investigation:
PTA : SNHL as the disease progresses.
Vestibular tests: hypo function
Treatment:
Bed rest
Nausea and vomiting: stemetil.
Surgery: if vertigo becomes disabling